Managing the Multiple Symptoms of Benign Prostatic Hyperplasia

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Medical Education Library

Managing the Multiple Symptoms of Benign Prostatic Hyperplasia

June 2012 · Vol. 61, No. 06 Suppl: S5-S10

By

Martin Miner, MD

References

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8. Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol. 2003;44(6):637-649.

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17. Tanguay S, Awde M, Brock G, et al. Diagnosis and management of benign prostatic hyperplasia in primary care. Can Urol Assoc J. 2009;3(3 suppl 2):S92-S100.

18. Roehrborn CG, Boyle P, Gould AL, Waldstreicher J. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology. 1999;53(3):581-589.

19. McVary KT, Roehrborn CG, Avins AL, et al. American Urological Association guideline: Management of benign prostatic hyperplasia (BPH). http://www.auanet.org/content/clinical-practice-guidelines/clinical-guidelines.cfm?sub=bph. Published 2010. Accessed May 16, 2012.

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24. Kristal AR, Arnold KB, Schenk JM, et al. Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol. 2008;167(8):925-934.

25. Yu HJ, Lin AT, Yang SS, et al. Non-inferiority of silodosin to tamsulosin in treating patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). BJU Int. 2011;108(11):1843-1848.

26. Chapple CR, Montorsi F, Tammela TL, Wirth M, Koldewijn E, Fernandez FE. for European Silodosin Study Group. Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double-blind, placebo- and active-controlled clinical trial performed in Europe. Eur Urol. 2011;59(3):342-352.

27. Kawabe K, Yoshida M, Homma Y. for Silodosin Clinical Study Group. Silodosin, a new alpha1A-adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men. BJU Int. 2006;98(5):1019-1024.

28. Roehrborn CG, Siami P, Barkin J, et al. for CombAT Study Group. The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol. 2010;57(1):123-131.

29. Kaplan SA, Gonzalez RR. Phosphodiesterase type 5 inhibitors for the treatment of male lower urinary tract symptoms. Rev Urol. 2007;9(2):73-77.

30. Mulhall JP, Guhring P, Parker M, Hopps C. Assessment of the impact of sildenafil citrate on lower urinary tract symptoms in men with erectile dysfunction. J Sex Med. 2006;3(4):662-667.

31. McVary KT, Roehrborn CG, Kaminetsky JC, et al. Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2007;177(4):1401-1407.

32. Stief CG, Porst H, Neuser D, Beneke M, Ulbrich E. A randomised, placebo-controlled study to assess the efficacy of twice-daily vardenafil in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol. 2008;53(6):1236-1244.

33. Porst H, McVary KT, Montorsi F, et al. Effects of once-daily tadalafil on erectile function in men with erectile dysfunction and signs and symptoms of benign prostatic hyperplasia. Eur Urol. 2009;56(4):727-735.

34. Broderick GA, Brock GB, Roehrborn CG, Watts SD, Elion-Mboussa A, Viktrup L. Effects of tadalafil on lower urinary tract symptoms secondary to benign prostatic hyperplasia in men with or without erectile dysfunction. Urology. 2010;75(6):1452-1458.

35. Porst H, Kim ED, Casabé AR, et al. LVHJ study team. Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial. Eur Urol. 2011;60(5):1105-1113.

36. Maselli G, Bergamasco L, Silvestri V, Gualà L, Pace G, Vicentini C. Tadalafil versus solifenacin for persistent storage symptoms after prostate surgery in patients with erectile dysfunction: a prospective randomized study. Int J Urol. 2011;18(7):515-520.

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39. Gacci M, Corona G, Salvi M, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2012;61(5):994-1003.

Table of Contents

Introduction

Managing the Multiple Symptoms of Benign Prostatic Hyperplasia — CME

The Treatment of Gout

Managing Type 2 Diabetes in Men

Meeting New Challenges with Antiplatelet Therapy in Primary Care

Coronary Heart Disease in Men

Addressing Key Questions with Statin Therapy — CME

DISCLOSURES

Dr. Miner has disclosed that he is a consultant for Eli Lilly.

SUPPORT

This activity was supported by an educational grant from Lilly USA, LLC.

This article reviews screening tools for benign prostatic hyperplasia (BPH) and steps to be taken to confirm a diagnosis of BPH. Among the treatment options for BPH, emphasis is placed on pharmacologic treatment with alpha₁-adrenergic blockers (AABs), 5-alpha-reductase inhibitors (5-ARIs), and phosphodiesterase-5 inhibitors (PDE-5Is). The two newest agents silodosin and tadalafil are discussed in greater detail.

CONTINUING MEDICAL EDUCATION

LEARNING OBJECTIVES

After reviewing this activity on benign prostatic hyperplasia, the reader will be able to:

Describe the key diagnostic steps.
Describe the role of non-pharmacologic interventions.
Compare the efficacy and safety of alpha₁- adrenergic blockers, 5-alpha-reductase inhibitors, and phosphodiesterase-5 inhibitors.
Describe strategies for treating multiple symptoms.

TARGET AUDIENCE

Family physicians and clinicians who wish to gain increased knowledge and greater competency regarding the management of patients with multiple symptoms of benign prostatic hyperplasia.

ACKNOWLEDGEMENT

Dr. Miner was paid an honorarium by and received editorial assistance from the Primary Care Education Consortium in the development of this activity.

DISCLOSURES

As a continuing medical education provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Primary Care Education Consortium (PCEC) to require any individual in a position to influence educational content to disclose the existence of any financial interest or other personal relationship with the manufacturer(s) of any commercial product(s).

Dr. Miner has disclosed that he is a consultant for Eli Lilly.

The medical accuracy and continuing medical education (CME) reviewer for this activity, Dr. Ron Pollack, has no real or apparent conflicts of interest to report.

PRIMARY CARE EDUCATION CONSORTIUM STAFF

Dr. Brunton has disclosed that he is on the advisory boards and speakers’ bureaus for Boehringer Ingelheim, Eli Lilly, Kowa, Novo Nordisk, Inc, and Teva Pharmaceuticals, and is on the advisory boards for Abbott and Sunovion.

Other PCEC staff have provided financial disclosure and have no conflicts of interest to resolve related to this activity.

CONFLICTS OF INTEREST

When individuals in a position to control content have reported financial relationships with one or more commercial interests, the Primary Care Education Consortium works with them to resolve such conflicts to ensure that the content presented is free of commercial bias. The content of this activity was vetted by the following mechanisms and modified as required to meet this standard:

Content peer-review by an external topic expert
Content peer-review by an external CME reviewer
Content validation by internal Primary Care Education Consortium clinical editorial staff

OFF-LABEL DISCLOSURE

In accordance with ACCME guidelines, the faculty author has been asked to disclose discussion on unlabeled or unapproved uses of drugs or devices during the course of the activity.

SPONSORSHIP

This activity is sponsored by the Primary Care Education Consortium.

ACCREDITATION

This journal-based CME activity, Managing the Multiple Symptoms of Benign Prostatic Hyperplasia, has been reviewed and is acceptable for up to 1.0 prescribed credit by the American Academy of Family Physicians. AAFP accreditation begins June 1, 2012. Term of approval is for one year from this date with option for yearly renewal.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MEDIUM

Text publication in the form of a journal article.

METHOD OF PHYSICIAN PARTICIPATION

To receive CME credit, please read the journal article, and upon completion go to: www.pceconsortium.org/menshealthBPH to complete the online evaluation to receive your certification of completion.

SUPPORT

This activity was supported by an educational grant from Lilly USA, LLC.

RI is a 53-year-old African-American man who is being seen by his family physician for a follow-up for dyslipidemia and hypertension. He reports that he is feeling well and that he has not observed any adverse events (AEs) from his medications. His current medications are an intermediate-dose statin, a thiazide diuretic, and a calcium channel blocker. RI reports that he has been very compliant with his medications, missing at most 1 dose every week or two.

During the visit, his physician notices that RI has yawned several times and that he appears tired. When asked how many hours he sleeps each night, RI indicates that he sleeps 7.5 to 8 hours most nights. On further questioning, RI admits that for the past 4 or 5 years, he has had to get up to go to the bathroom during the night, after which he often has trouble falling asleep, and that this nocturia currently occurs 3 or 4 times a night. When asked whether he has noticed any other changes over the past few years, RI says that he has noted an increase in his waist circumference (now 38.5 inches) and a few more aches and pains. When asked whether he has experienced any changes in sexual function, RI acknowledges that occasionally he has had difficulty maintaining an erection. He also indicates that he has accepted that these changes are a result of getting older.